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(영문) 대전지방법원 2020.10.15 2018구합108116
업무정지등처분취소
Text

1. All of the plaintiff's claims are dismissed.

2. All the costs of lawsuit are assessed against the Plaintiff.

Reasons

1. Details of the disposition;

A. The Plaintiff is a herb doctor who operates the “Chanwon” in Daejeon Jung-gu, Daejeon (hereinafter “Chanwon”).

B. On October 18, 2016, the Defendant Minister conducted an on-site investigation on the instant Institute (the period subject to the investigation: from September 2013 to August 2016; hereinafter “on-site investigation”) with respect to the instant Institute.

C. As a result of the instant on-site investigation, on September 27, 2018, Defendant Minister issued a disposition to suspend the business of the Plaintiff on 69 days (from May 6, 2019 to July 13, 2019) pursuant to Article 98(1)1 of the National Health Insurance Act (hereinafter “instant disposition to suspend business”).

2. Details of unfair amount calculation;

(a) Unfair amount: 40,103,940 won; and

(b) False claims, such as detailed calculation details of medicine expenses: 40,103,940 won - In the case of a certain number of persons, the medicine expenses, etc. that are administered even though they did not actually D, etc., and a claim for medical care benefit costs is filed;

3. Grounds related to July 69% of the total amount of costs of health care benefit (from September 2013 to August 36, 2016) for review of the calculation of the administrative disposition: Criteria for business suspension and imposition of penalty surcharges under Article 70 (1) [Attachment Table 5] of the former Enforcement Decree of the National Health Insurance Act (Amended by Presidential Decree No. 27508, Sep. 22, 2016);

D. On October 29, 2018, Defendant Corporation notified Defendant Minister of the instant disposition of the suspension of business, notified the Plaintiff of the scheduled recovery of medical care benefit costs. On November 19, 2018, Defendant Corporation issued a disposition to recover KRW 40,103,940 (total 14,585 items) of medical care benefit costs claimed by the Plaintiff in falsehood pursuant to Article 57 of the National Health Insurance Act (hereinafter “instant recovery disposition”); and, in addition, the instant disposition of suspension of business and the instant disposition (hereinafter “each of the instant dispositions”).

E. Meanwhile, on the other hand, the Daejeon District Prosecutors' Office from September 2, 2013 to September 1, 2016: (a) the fact that the Plaintiff was from September 2, 2013 to September 1, 2016 is about 136 internal patients.

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